Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease (PID) is an infection in the internal female organs, which can affect the uterus, ovaries and fallopian tubes. Each year, according to the National Institute of Allergy and Infectious Diseases (NIAID), more than 1 million women in the United States experience an episode of PID, with the highest rate occurring in the teenage population. NIAID believes more than 100,000 women become infertile (Read about "Infertility") each year because of PID and many of the 70,000 "tubal" or ectopic pregnancies each year are related to PID complications. According to the Centers for Disease Control and Prevention (CDC), over 150 women die from PID each year.

Causes of PID

PID occurs when bacteria (Read about "Microorganisms") move from the vagina or cervix up into the upper internal female reproductive organs. According to the American Academy of Family Physicians (AAFP), the most common cause of PID is exposure to a sexually transmitted disease (STD), usually gonorrhea or chlamydia. (Read about "STD's") These diseases are passed on during sexual intercourse and are spread to the cervix during sex. AAFP says that when the cervix becomes infected with gonorrhea or chlamydia, these bacteria can spread through the cervix into the reproductive organs.

Although exposure to gonorrhea or chlamydia is the most common cause of PID, AAFP believes other potential causes could be:

• Normal bacteria in the vagina spreading to reproductive organs and abdomen with no known cause
• Infection after certain surgical procedures like "D & C" (dilatation and curettage), insertion of an IUD (intrauterine device for birth control) or abortion. (Read about "Birth Control")
• After the cervix is treated due to an abnormal Pap test (Read about "Cervical Cancer")
• When disease-causing bacteria organisms migrate into the female reproductive organs for any reason

The presence of bacterial vaginosis (BV) can increase a woman's risk of developing PID. (Read about "Bacterial Vaginosis") Women who perform vaginal douching have a greater risk of PID also, according to CDC.

Symptoms of PID

A woman with PID may experience no symptoms, severe symptoms or anything in-between. According to CDC, up to two-thirds of cases of PID are overlooked by both women and their healthcare providers or have a delayed diagnosis because of vague or mild symptoms, particularly if it is caused by chlamydia. The symptoms of PID can vary widely from person to person, but can include:

• lower abdominal pain or tenderness in abdomen
• pain or tenderness during pelvic exam when the cervix is touched
• unusual vaginal discharge, usually yellow or green, that may have a foul odor (Read about "Vaginal Discharge")
• irregular menstrual bleeding (Read about "Menstrual Disorders")
• fever with or without nausea or vomiting
• pain during intercourse

How is PID diagnosed?

According to the CDC, diagnosis can be difficult because the symptoms may be subtle, vague or mild. There are no specific tests for PID so diagnosis is usually based on a detailed health history, physical exam, blood tests (Read about "Laboratory Testing") and sometimes various cultures (a swab of fluid that is tested for infection). Pelvic ultrasound (Read about "Ultrasound Imaging") or other diagnostic procedures may also be used.

PID treatments

NIAID says that no over-the-counter treatment is available for PID. If a woman has symptoms or has been exposed to an STD, she should see her healthcare provider right away, because waiting even a few days can cause the infection to spread, causing more pain or internal damage. If a woman is very sick, pregnant or has an HIV infection (Read about "HIV / AIDS") she will usually be hospitalized. According to NIAID, the most common treatments for PID will include:

• at least two antibiotics (Read about "Antibiotics")
• follow-up visit with healthcare provider 2-3 days after treatment is started
• long-term follow-up and other treatment as necessary to treat complications

A woman may feel better very soon after starting antibiotics, but it is critical that all prescribed medicine is taken, even if the symptoms go away before the medicine is finished. Even when symptoms are gone or improved, the antibiotics still have work to do so the infection is treated completely and eliminated. Stopping medicine early may mean that the same medicine won't be effective in the future, if bacteria develop resistance.

According to CDC, PID can be cured with antibiotics, but the longer women delay treatment, the more likely they are to develop severe or long-term complications like infertility or ectopic (tubal) pregnancy. Antibiotics will not reverse damage that has already occurred. The CDC also recommends treatment of sex partners, even if the partners have no symptoms, to lower the woman's risk of becoming infected again.

Complications of PID

According to AAFP, early and complete treatment can help prevent possible long-term complications of PID, including:

• permanent damage to internal organs which sometimes requires surgery
• infertility due to scar tissue and adhesions
• tubal (ectopic) pregnancy due to scar tissue
• chronic pain
• increased risk of future episodes of PID if exposed to STD's

Each episode of PID places a woman at more risk of damage and other complications.

Can PID be prevented?

According to NIAID, women can play a very active role in preventing PID. Any symptoms should be reported quickly to her healthcare provider, as early treatment of infection can prevent development of PID. CDC states that the main cause of PID is an untreated STD, so women can protect themselves by getting early treatment and decreasing their risk of exposure to an STD by:

• Using latex condoms correctly every time for vaginal, oral and anal sex from the beginning of sexual contact until there is no longer skin contact. Other forms of birth control like oral contraceptives, shots or implants don't protect against STD's so a condom should also be used.
• Limiting number of sex partners. Multiple sex partners increase risk of STD's, so a woman can practice abstinence or mutual monogamy (sex with only one uninfected partner)
• Having regular check-ups if sexually active
• Abstaining from sex until all partners have been treated and cured of possible STD's

Related Information:

    Infertility Treatments

    Genital Health - Female